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Risk estimation for idiopathic normal-pressure hydrocephalus: development and validation of a brain morphometry-based nomogram

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Abstract
Objectives: To develop and validate a nomogram based on MRI features for predicting iNPH.

Methods: Patients aged ≥ 60 years (clinically diagnosed with iNPH, Parkinson's disease, or Alzheimer's disease or healthy controls) who underwent MRI including three-dimensional T1-weighted volumetric MRI were retrospectively identified from two tertiary referral hospitals (one hospital for derivation set and the other for validation set). Clinical and imaging features for iNPH were assessed. Deep learning-based brain segmentation software was used for 3D volumetry. A prediction model was developed using logistic regression and transformed into a nomogram. The performance of the nomogram was assessed with respect to discrimination and calibration abilities. The nomogram was internally and externally validated.

Results: A total of 452 patients (mean age ± SD, 73.2 ± 6.5 years; 200 men) were evaluated as the derivation set. One hundred eleven and 341 patients were categorized into the iNPH and non-iNPH groups, respectively. In multivariable analysis, high-convexity tightness (odds ratio [OR], 35.1; 95% CI: 4.5, 275.5), callosal angle < 90° (OR, 12.5; 95% CI: 3.1, 50.0), and normalized lateral ventricle volume (OR, 4.2; 95% CI: 2.7, 6.7) were associated with iNPH. The nomogram combining these three variables showed an area under the curve of 0.995 (95% CI: 0.991, 0.999) in the study sample, 0.994 (95% CI: 0.990, 0.998) in the internal validation sample, and 0.969 (95% CI: 0.940, 0.997) in the external validation sample.

Conclusion: A brain morphometry-based nomogram including high-convexity tightness, callosal angle < 90°, and normalized lateral ventricle volume can help accurately estimate the probability of iNPH.
Author(s)
Su Young YunKyu Sung ChoiChong Hyun SuhSoo Chin KimHwon HeoWoo Hyun ShimSungyang JoSun Ju ChungJae-Sung LimJae-Hong LeeDonghyun KimSeon-Ok KimWooseok JungHo Sung KimSang Joon KimJi-Hoon Kim
Issued Date
2023
Type
Article
Keyword
Deep learningHydrocephalusNomogramsNormal pressure
DOI
10.1007/s00330-023-09612-1
URI
https://oak.ulsan.ac.kr/handle/2021.oak/16039
Publisher
EUROPEAN RADIOLOGY
Language
한국어
ISSN
0938-7994
Citation Volume
33
Citation Number
9
Citation Start Page
6145
Citation End Page
6156
Appears in Collections:
Medicine > Nursing
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